Provider Demographics
NPI:1508897281
Name:KRYNYCKY, IHOR ALEXANDER (MD)
Entity Type:Individual
Prefix:
First Name:IHOR
Middle Name:ALEXANDER
Last Name:KRYNYCKY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:829 N CENTER AVE
Mailing Address - Street 2:SUITE 260
Mailing Address - City:GAYLORD
Mailing Address - State:MI
Mailing Address - Zip Code:49735-1595
Mailing Address - Country:US
Mailing Address - Phone:989-731-7729
Mailing Address - Fax:989-731-7983
Practice Address - Street 1:829 N CENTER AVE
Practice Address - Street 2:SUITE 260
Practice Address - City:GAYLORD
Practice Address - State:MI
Practice Address - Zip Code:49735-1595
Practice Address - Country:US
Practice Address - Phone:989-731-7729
Practice Address - Fax:989-731-7983
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2008-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301060478207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
DA0074OtherMEDICARE RR PROV ID
MI0406910201OtherBCBSM PROVIDER NUMBER
MI4605008Medicaid
11383155OtherCAQH PROVIDER ID
MI0406910201OtherBCBSM PROVIDER NUMBER